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Three-dimensional hip and knee kinematics during walking, running, and single-limb drop landing in females with and without genu valgum

      Highlights

      • Hip and knee kinematics during three dynamic tasks in healthy subjects with and without genu valgum were examined.
      • Tasks studied were walking, running and single-limb drop landing.
      • Group differences did not generally increase with higher force tasks.
      • The valgus group showed decreased hip flexion, increased hip adduction and increased knee abduction across tasks
      • The valgus subjects also showed increased knee external rotation during running and landing

      Abstract

      Background

      Dynamic knee valgus in females has been associated with various knee pathologies. Abnormal 3D hip and knee kinematics contribute prominently to this presentation, and these may become more aberrant with more demanding tasks. Underlying genu valgus may also accentuate such kinematics, but this effect has never been tested. Therefore, the purpose of this study was to compare 3D hip and knee kinematics during walking, running, and single-limb drop landing in females with and without genu valgus malalignment. We expected abnormal kinematics to become more evident in the valgus subjects as task demands increased.

      Methods

      Eighteen healthy females with genu valgum and 18 female controls with normal alignment underwent 3D motion analysis while performing walking, running, and single-limb drop-landing trials. Sagittal, frontal, and transverse plane hip and knee kinematics were compared between groups across tasks using analyses of variance and between-group effect sizes.

      Findings

      Group differences did not generally increase with higher forces. The valgus females demonstrated decreased hip flexion (ES = 0.72–0.88) and increased knee abduction (ES = 0.87–1.47) across the tasks. During running and single-limb drop landing, they showed increased knee external rotation (ES = 0.69–0.73). Finally, during walking, the valgus females showed increased hip adduction (ES = 0.69).

      Interpretation

      These results suggest that females with genu valgus alignment utilize aberrant hip and knee mechanics previously associated with dynamic valgus in the literature, but that these pathomechanics do not generally worsen with rising task demands. Healthy females that present with genu valgus may be natively at elevated risk for knee pathology.

      Keywords

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      References

        • Ajuied A.
        • Wong F.
        • Smith C.
        • Norris M.
        • Earnshaw P.
        • Back D.
        • Davies A.
        Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis.
        Am. J. Sports Med. 2014; 42: 2242-2252
        • Alentorn-Geli E.
        • Myer G.D.
        • Silvers H.J.
        • et al.
        Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: mechanisms of injury and underlying risk factors.
        Knee Surg. Sports Traumatol. Arthrosc. 2009; 17: 705-729
        • Barendrecht M.
        • Lezeman H.
        • Duysens J.
        • Smits-Engelsman B.
        Neuromuscular training improves knee kinematics, in particular in valgus aligned adolescent team handball players of both sexes.
        J. Strength Cond. Res. 2011; 25: 575-584
        • Barrios J.
        • Strotman D.
        A sex comparison of ambulatory mechanics relevant to osteoarthritis in individuals with and without asymptomatic varus knee alignment.
        J. Appl. Biomech. 2014; 30: 632-636
        • Barrios J.
        • Higginson J.
        • Royer T.
        • et al.
        Static and dynamic correlates of the knee adduction moment in healthy knees ranging from normal to varus-aligned.
        Clin. Biomech. 2009; 24: 850-854
        • Boling M.
        • Padua D.
        • Marshall S.
        • et al.
        Gender differences in the incidence and prevalence of patellofemoral pain syndrome.
        Scand. J. Med. Sci. Sports. 2010; 20: 725-730
        • Butler R.J.
        • Barrios J.A.
        • Royer T.
        • Davis I.S.
        Frontal-plane gait mechanics in people with medial knee osteoarthritis are different from those people with lateral knee osteoarthritis.
        Phys. Ther. 2011; 91: 1235-1243
        • Chappell J.
        • Creighton A.
        • Giuliani C.
        • Yu B.
        • Garrett W.
        Kinematics and electromyography of landing preparation in vertical stop-jump risks for noncontact anterior cruciate ligament injury.
        Am. J. Sports Med. 2007; 35: 235-241
        • Chaudhari A.M.
        • Andriacchi T.P.
        The mechanical consequences of dynamic frontal plane limb alignment for non-contact ACL injury.
        J. Biomech. 2006; 39: 330-338
        • Culvenor A.G.
        • Schache A.G.
        • Vincenzino B.
        • Pandy M.G.
        • Collins N.J.
        • Cook J.L.
        • Crossley K.M.
        Are knee biomechanics different in those with and without patellofemoral osteoarthritis after anterior cruciate ligament reconstruction?.
        Arthritis Rheum. 2014; 66: 1566-1570
        • De Loes M.
        • Dahlstedt J.
        • Thomee R.
        A 7-year study on risks and costs of knee injuries in male and female youth participants in 12 sports.
        Scand. J. Med. Sci. Sports. 2000; 10: 90-97
        • Eckstein F.
        • Wirth W.
        • Hudelmaier M.
        • Stein V.
        • Lengfelder V.
        • Cahue S.
        • Marshall M.
        • Prasad P.
        • Sharma L.
        Patterns of femorotibial cartilage loss in knees with neutral, varus, and valgus alignment.
        Arthritis Rheum. 2008; 59: 1563-1570
        • Ericksen H.M.
        • Thomas A.C.
        • Gribble P.A.
        • Doebel S.C.
        • Pietrosimone B.G.
        Immediate effects of real-time feedback on jump-landing kinematics.
        J. Orthop. Sports Phys. Ther. 2015; 45: 112-118
        • Farr S.
        • Kranzl A.
        • Pablik E.
        • Kaipel M.
        • Ganger R.
        Functional and radiographic consideration of lower limb malalignment in children and adolescents with idiopathic genu valgum.
        J. Orthop. Res. 2014; : 1362-1370
        • Felson D.T.
        • Niu J.
        • Gross D.
        • Englund M.
        • Sharma L.
        • Cooke T.D.V.
        • Guermazi A.
        • Roemer F.W.
        • Segal N.
        • Goggins J.M.
        • Lewis E.
        • Eaton C.
        • Nevitt M.C.
        Valgus alignment is a risk factor for lateral knee osteoarthritis incidence and progression: findings from MOST and the Osteoarthritis Initiative.
        Arthritis Rheum. 2013; 65: 355-362
        • Ferber R.
        • Noehren B.
        • Hamill J.
        • Davis I.S.
        Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics.
        J. Orthop. Sports Phys. Ther. 2010; 40: 52-58
        • Fox A.S.
        • Bonacci J.
        • McLean S.G.
        • Spittle M.
        • Saunders N.
        What is normal? Female lower limb kinematic profiles during athletic tasks used to examine anterior cruciate ligament injury risk: a systematic review.
        Sports Med. 2014; 44: 815-832
        • Freedman K.B.
        • Glasgow M.T.
        • Glasgow S.G.
        • Bernstein J.
        Anterior cruciate ligament injury and reconstruction among university students.
        Clin. Orthop. Relat. Res. 1998; 356: 208-212
        • Grood E.S.
        • Suntay W.J.
        A joint coordinate system for the clinical description of three-dimensional motions: application to the knee.
        J. Biomech. Eng. 1983; 105: 136-144
        • Guccione A.A.
        Arthritis and the process of disablement.
        Phys. Ther. 1994; 74: 408-414
        • Hewett T.E.
        • Lindenfeld T.N.
        • Riccobene J.V.
        • et al.
        The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study.
        Am. J. Sports Med. 1999; 27: 699-706
        • Hewett T.E.
        • Myer G.D.
        • Ford K.R.
        • Heidt R.S.
        • Colosimo S.J.
        • McLean S.G.
        • van den Bogert A.J.
        • Paterno M.V.
        • Succop P.
        Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study.
        Am. J. Sports Med. 2005; 33: 492-501
        • Hinman R.S.
        • May R.L.
        • Crossley K.M.
        Is there an alternative to the full-length radiograph for determining knee joint alignment in osteoarthritis?.
        Arthritis Rheum. 2006; 55: 306-313
        • Ireland M.L.
        Anterior cruciate ligament injury in female athletes: epidemiology.
        J. Athl. Train. 1999; 34: 150-154
        • Murphy L.
        • Schwartz T.A.
        • Helmick C.G.
        • Renner J.B.
        • Tudor G.
        • Koch G.
        • Dragomir A.
        • Kalsbeek W.D.
        • Luta G.
        • Jordan J.M.
        Lifetime risk of symptomatic knee osteoarthritis.
        Arthritis Rheum. 2008; 59: 1207-1213
        • Myer G.D.
        • Ford K.R.
        • Barber Foss K.D.
        • Goodman A.
        • Ceasar A.
        • Rauh M.J.
        • Divine J.G.
        • Hewett T.E.
        The incidence and potential pathomechanics of patellofemoral pain in female athletes.
        Clin. Biomech. 2010; 25: 700-707
        • Myer G.D.
        • Ford K.R.
        • Di Stasi S.L.
        • Barber Foss K.D.
        • Micheli L.J.
        • Hewett T.E.
        High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: is PFP itself a predictor for subsequent ACL injury?.
        Br. J. Sports Med. 2015; 49: 118-122
        • Natri A.
        • Kannus P.
        • Jarvinen M.
        Which factors predict the long-term outcome in chronic patellofemoral pain syndrome? A 7-yr prospective follow-up study.
        Med. Sci. Sports Exerc. 1998; 30: 1572-1577
        • Nyland J.A.
        • Caborn D.N.
        Physiological coxa varus-genu valgus influences internal knee and ankle joint moments in females during crossover cutting.
        Knee Surg. Sports Traumatol. Arthrosc. 2004; 12: 285-293
        • Pollard C.D.
        • Sigward S.M.
        • Powers C.M.
        Limited hip and knee flexion during landing is associated with increased frontal plane knee motion and moments.
        Clin. Biomech. 2010; 25: 142-146
        • Powers C.M.
        The influence of altered lower extremity kinematics on patellofemoral dysfunction: a theoretical perspective.
        J. Orthop. Sports Phys. Ther. 2003; 33: 639-646
        • Sharma L.
        • Chmiel J.S.
        • Almagor O.
        • Felson D.
        • Guermazi A.
        • Roemer F.
        • Lewis C.E.
        • Segal N.
        • Torner J.
        • Cooke T.D.
        • Hietpas J.
        • Lynch J.
        • Nevitt M.
        The role of varus and valgus alignment in the initial development of knee cartilage damage by MRI: the MOST study.
        Ann. Rheum. Dis. 2013; 72: 235-240
        • Srikanth V.K.
        • Fryer J.L.
        • Zhai G.
        • Winzenberg T.M.
        • Hosmer D.
        • Jones G.
        A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis.
        Osteoarthr. Cartil. 2005; 13: 769-781
        • Taunton J.E.
        • Ryan M.B.
        • Clement D.B.
        • McKenzie D.C.
        • Lloyd-Smith D.R.
        • Zumbo B.D.
        A retrospective case–control analysis of 2002 running injuries.
        Br. J. Sports Med. 2002; 36: 95-101
        • Thomas M.J.
        • Wood L.
        • Selfe J.
        • Peat G.
        Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review.
        BMC Musculoskelet. Disord. 2010; 11 (Sept. 9): 201
        • Vanwanseele B.
        • Parker D.
        • Coolican M.
        Frontal knee alignment: three-dimensional marker positions and clinical assessment.
        Clin. Orthop. Relat. Res. 2009; 467: 504-509
        • Weidow J.
        • Tranberg R.
        • Saari T.
        • Karrholm J.
        Hip and knee joint rotations differ between patients with medial and lateral knee osteoarthritis: gait analysis of 30 patients and 15 controls.
        J. Orthop. Res. 2006; 24: 1890-1899
        • Witvrouw E.
        • Lysens R.
        • Bellemans J.
        • Cambier D.
        • Vanderstraeten G.
        Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study.
        Am. J. Sports Med. 2000; 28: 480-489